Due to its unique advantages, virtual reality rehabilitation (VR) training has been widely used in the field of rehabilitation therapy, but there is a lack of study on its application efficacy in patients with sudden deafness and vertigo.
To observe the efficacy of coventional vestibular rehabilitation training and vestibular rehabilitation training assisted by VR technology in patients with sudden deafness and vertigo.
From January 2022 to January 2023, 84 patients with sudden deafness and vertigo were selected from the Department of Otolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University and randomly divided into the two groups, with 42 cases in each group. The control group was given drug therapy combined with coventional vestibular rehabilitation training, while the observation group was given vestibular rehabilitation training assisted by VR technology on the basis of drug therapy. The Dizziness Disorder Scale (DHI) and Hospital Anxiety and Depression Scale (HADS) were respectively used to evaluate the two groups before intervention, 7 and 14 days after the intervention.
Finally 81 patients completed the trial, including 41 patients in the observation group and 40 patients in the control group. Group and time had interaction effects on DHI-Function (F), DHI-Emotion (E) and DHI-Physical (P) scores and total DHI score (P<0.05). The main effects of group and time on DHI sub-scores and total score were significant (P<0.05). There was no significant difference between the two groups in DHI sub-scores and total score before intervention (P>0.05) ; DHI sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). DHI sub-scores and total score in the observation group were higher than the control group after 7 and 14 days of intervention (P<0.05). Group and time had interaction effects on HADS-Anxiety Scale (A), HADS-Depression Scale (D) scores and total HADS score (P<0.05). The main effect of group and time on HADS sub-scores and total score was significant (P<0.05). There was no significant difference in HADS sub-scores and total score between the two groups before intervention (P>0.05). HADS sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). After 7 and 14 days of intervention, there was no significant difference in HADS sub-scores and total score between the two groups (P>0.05) .
Vestibular rehabilitation training is effective for patients with sudden deafness and vertigo, and the vestibular rehabilitation training assisted by VR technology can obviously improve patients' balance disorders and quality of life.
Acute cerebral infarction is a critical condition in patients with acute vestibular syndrome (AVS). AVS presents suddenly with severe symptoms. The sensitivity of CT in diagnosing acute cerebral infarction is low, and MRI, which is more accurate, is not always immediately available. This makes the diagnosis of acute cerebral infarction presenting as AVS challenging. Therefore, it is necessary to explore suitable examination and evaluation methods for patients with AVS.
To analyze the risk factors associated with acute cerebral infarction in patients with AVS, in order to provide a reference for the diagnosis of acute cerebral infarction in AVS and to maximize the critical treatment window for these patients.
A total of 102 patients with AVS admitted to the Department of Neurology, the Fourth Hospital of Harbin Medical University from April 2021 to July 2022 were included in the study. Clinical signs were recorded, and MRI results were used as the gold standard for the diagnosis of cerebral infarction. Patients were divided into the cerebral infarction group (n=16) and non-cerebral infarction group (n=86). The clinical characteristics of the two groups were compared. Univariate and multivariate Logistic regression analyses were used to explore factors influencing the occurrence of cerebral infarction in AVS. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of these factors.
The proportions of patients with a history of smoking, alcohol consumption, positive Head-Impulse-Nystagmus-Test-of-Skew (HINTS) tests, and higher ABCD2 scores were significantly higher in the cerebral infarction group (P<0.05). Univariate Logistic regression analysis indicated that positive HINTS, ABCD2 scores, history of smoking, alcohol consumption, and hearing loss were factors influencing the occurrence of cerebral infarction. Multivariate analysis showed that positive HINTS (OR=99.043, 95%CI=8.120-1 208.090) and ABCD2 scores (OR=2.820, 95%CI=1.188-6.696) were the influencing factors (P<0.05). The areas under the ROC curve (AUC) for predicting cerebral infarction using combined indicators, positive HINTS, ABCD2 scores, history of smoking, alcohol consumption, and hearing loss were 0.949, 0.874, 0.734, 0.643, 0.649, and 0.604, respectively.
The proportion of non-cerebral infarction is higher in patients with AVS, with vestibular neuritis being the most common. Positive HINTS and ABCD2 scores are closely related to the occurrence of cerebral infarction in patients with AVS.
Benign paroxysmal positional vertigo (BPPV) is a common clinical disease characterized by self-limiting and easy recurrence. Manual reduction is effective but residual symptoms may occur in some patients after reduction. In recent years, there have been many studies focus on the influencing factors of therapeutic efficiency of BPPV, while the comparison among specific causes and factors influencing residual symptoms remain to be further investigated.
To analyze the clinical features of secondary BPPV, investigate the effect of etiological classification of BPPV on the recurrence rate, and clarify the risk factors of residual symptoms after BPPV reduction.
A total of 340 patients diagnosed with BPPV were enrolled in the vertigo clinic of the Department of Otorhinolaryngology Head and Neck Surgery and Otology Department of the First Hospital of Jilin University from April 2019 to April 2021, and all of them agreed to manual reduction. The included patients were divided into the primary BPPV (the primary group) and secondary BPPV (the secondary group) groups according to the presence or absence of primary disease. The secondary group was further divided into five subgroups according to different etiologies, including sudden sensorineural hearing loss (SSNHL), vestibular migraine (VM), Meniere disease (MD), vestibular neuritis (VN), and others (such as cranial and ear surgery, Hunt syndrome, temporal bone fracture, etc.). The clinical features and prognosis were compared between the primary group and the secondary group. Follow-up to 3 months after the first reduction, the patients were divided into the residual symptom group and non-residual symptom group according to the occurrence of residual symptoms. The differences were compared in clinical characteristics and scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) at different periods (at diagnosis, 4 weeks after treatment, and 3 months after treatment) between the two groups, and the independent risk factors of residual symptoms after BPPV reduction were analyzed.
Among the 340 patients, 184 (54.1%) were in the primary group and 156 (45.9%) were in the secondary group. Compared with the primary group, the patients of the secondary group were younger, and the proportion of patients who underwent more than two reductions was higher, the success rate of the first reduction was lower; and the recurrence rate within 3 months, incidence of residual symptoms, SAS score at diagnosis, and SDS score at diagnosis in the primary group were higher than those in the secondary group, with significant differences (P<0.05). There were statistically significant differences in the age of patients with different etiologies of secondary BPPV (P<0.05), and the age of patients with other etiologies (such as cranial and ear surgery, Hunt syndrome, temporal bone fracture, etc.) was lower than that of patients with SSNHL, VM, MD, and VN groups (P<0.05). There were no significant differences in gender, semicircular canal involvement, number of reductions, success rate of the first reduction, recurrence rate within 3 months, incidence of residual symptoms, SAS and SDS scores at different times among different etiology groups of secondary BPPV (P>0.05). There were 133 patients in residual symptom group and 207 patients in the non-residual symptom group. The main residual symptoms were dizziness (59.40%, 79/133), instability (24.06%, 32/133) and head and neck discomfort (9.77%, 13/133), and 6.77% (9/133) had two or more symptoms. The proportion of secondary BPPV and more than two reductions in the residual symptom group was higher than that in the non-residual symptom group (P<0.05), and the proportion of recurrence was less, the SAS and SDS scores at diagnosis, 4 weeks after treatment, and 3 months after treatment were higher than those in the non-residual symptom group (P<0.01). The results of multivariate Logistic regression analysis showed that SAS score at diagnosis (OR=1.231, 95%CI=1.117-1.357, P<0.001) and SDS score at diagnosis (OR=1.209, 95%CI=1.113-1.314, P<0.001) were influencing factors for the occurrence of residual symptoms after reduction in BPPV patients.
Secondary BPPV is characterized by a high incidence of residual symptoms and recurrence rate after reduction. Anxiety and depression can affect the occurrence of residual symptoms after reduction.
